Current Treatment of Malignant Hypertension

A MAN who is 42 years old has a blood pressure of 230/150 mm Hg. Does he have malignant hypertension? Should the blood pressure be lowered immediately or gradually? The answers to these questions require a clear concept of the nature and treatment of malignant hypertension. Unfortunately, there is no single, all-inclusive definition of malignant hypertension. The disease is actually a clinical syndrome characterized by severe diastolic hypertension and varying degrees of retinal or renal changes or both. It may be accompanied by visual impairment, headache, nausea, vomiting, a variety of neurologic abnormalities, and rapid deterioration of renal function. The pretreatment diastolic blood pressure usually exceeds 130 mm Hg, although occasional patients may have the typical syndrome with lower blood pressure levels. A few patients seem to tolerate equally severe hypertension without ever developing the syndrome, so that it is not possible to predict which patient will develop the typical